Summary & Overview
CPT 99307: Subsequent Nursing Facility Evaluation and Management
CPT code 99307 represents subsequent nursing facility care for the evaluation and management of patients, focusing on those who are stable, recovering, or improving. This code is widely used in skilled nursing facilities across the United States and is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The service typically involves a problem focused interval history, examination, and straightforward medical decision making, with about 10 minutes spent per patient encounter.
This publication provides a comprehensive overview of CPT code 99307, including payer coverage, clinical context, and policy updates relevant to facility-based care. Readers will gain insights into benchmarks for utilization, reimbursement trends, and the regulatory landscape affecting subsequent nursing facility evaluation and management services. The analysis also highlights the importance of accurate coding and documentation for compliance and quality reporting in skilled nursing settings. Key modifiers and associated taxonomies are discussed to clarify billing practices and ensure proper claim submission. The information is designed to support healthcare professionals, administrators, and policy analysts in understanding the national significance of CPT code 99307 within the broader context of post-acute care.
CPT Code Overview
CPT code 99307 is used for subsequent nursing facility care, specifically for the evaluation and management of a patient. This service requires at least two of three key components: a problem focused interval history, a problem focused examination, and straightforward medical decision making. Counseling and coordination of care with other physicians, qualified health care professionals, or agencies are provided as needed, consistent with the nature of the patient's problems and their needs. Typically, the patient is stable, recovering, or improving, and the service involves approximately 10 minutes spent at the bedside and on the patient's facility floor or unit. The typical site of service for CPT code 99307 is a skilled nursing facility, which is a facility-based setting (Place of Service 31).
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an elderly individual residing in a skilled nursing facility who is stable, recovering, or improving. The patient may have conditions such as difficulty walking, bed confinement, a history of falls, amnesia, or be receiving palliative care. During a subsequent nursing facility visit, the physician or qualified healthcare professional performs a problem-focused interval history and examination, and makes straightforward medical decisions. The visit typically lasts about 10 minutes and may include counseling or coordination of care with other providers or agencies, tailored to the patient's needs.
Coding Specifications
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Modifiers:
25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. Used when an E/M service is distinct from other procedures performed on the same day.59: Distinct Procedural Service. Used to indicate that a procedure or service is separate and distinct from other services provided on the same day.
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Provider Taxonomies:
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